Prevention of healthcare-associated infections and a restrictive antibiotics policy in the Nordic countries have contributed to a low prevalence of multi-drug resistant microorganisms, compared to many other countries. This requires professional competences acquired through education in infection control, both in hospitals and in primary health care.
Evaluations are essential to judge the success of public health programmes. In Europe, the proportion of public health programmes that undergo evaluation remains unclear. The European Centre for Disease Prevention and Control sought to determine the frequency of evaluations amongst European national public health programmes by using national hand hygiene campaigns as an example of intervention.
Antibiotic resistance is an increasing community problem and is related to antibiotic use. If antibiotic use could be reduced, the tide of increasing resistance could be stemmed. e-Bug is a European project involving 18 European countries, partly funded by The Directorate-General for Health and Consumers (DG SANCO) of the European Commission. It aims to develop and disseminate across Europe a junior and senior school teaching pack and web site (hosting the lesson plans and complementary games) that teach young people about prudent antibiotic use, microbes, transmission of infection, hygiene and vaccines. The aim of e-Bug is to increase young peoples understanding, through enjoyable activities, of why it is so important to use antibiotics correctly in order to control antibiotic resistance, and to have good hand and respiratory hygiene to help reduce the spread of infection. Within the senior school pack the sexual transmission of infections has also been included, as the peak age of chlamydial infection is in 16-24 year olds. Teachers, young people and the consortium of 18 countries were closely involved with agreeing learning outcomes and developing the resource activities. Young people helped create the characters and microbe artwork. The resources have been translated, adapted for and disseminated to schools across 10 countries in Europe, and endorsed by the relevant government departments of health and education. The web site has been accessed from >200 countries. The resources will be translated into all European Union languages, and have been used to promote European Antibiotic Awareness Day and better hand and respiratory hygiene during the influenza pandemic in 2009.
Health promotion interventions aimed at children and young people have the potential to lay the foundations for healthy lifestyles. One such intervention, e-Bug, aims to provide schoolchildren with knowledge of prudent antibiotic use and how to reduce the spread of infection. Many children and schools approach learning in different ways; therefore, it is essential to research school needs and the variety of learning styles when creating any school resources. This article outlines the process involved during the development of a pan-European educational resource, and identifies the final pack layout, based on feedback from teacher focus groups, student questionnaires and European partner discussions.
e-Bug is a pan-European antibiotic and hygiene teaching resource that aims to reinforce awareness in school children of microbes, prudent antibiotic use, hygiene and the transmission of infection. Prior to the production of the resource, it was essential to examine the educational structure across each partner country and assess what school children were being taught on these topics. A questionnaire was devised for distribution to each European partner (Belgium, Czech Republic, Denmark, England, France, Greece, Italy, Poland, Portugal and Spain), exploring their educational structure and examining educational resources or campaigns currently available. From the data collected it was evident that the majority of European schools have structured hand hygiene practices in place from a young age. The curricula in all countries cover the topic of human health and hygiene, but limited information is provided on antibiotics and their prudent use. School educational resources that link to the national curriculum and implement National Advice to the Public campaigns in the classroom are limited. The Microbes en question mobile health education campaign in France is an example of a successful childrens education campaign and an innovative programme. Evaluation of the impact of school education on attitude and change of behaviour is also limited throughout many European countries. Not enough is currently being done across Europe to educate school children on the importance of appropriate antibiotic use and antibiotic resistance. The data from this research were used to develop e-Bug, a European Union-funded antibiotic and hygiene teaching resource.
Bacterial resistance to antimicrobial agents in primary healthcare is low in Denmark compared with most other European countries. Denmark has a vaccination programme for children that recommends immunization against 10 infectious diseases, including a heptavalent pneumococcal conjugate vaccine (PCV7) and a vaccine against human papillomavirus (HPV). Outbreaks in schools due to other infectious illnesses are well recognized and have seasonal variations. A quarter of young people have had a sexually transmitted disease before the age of 25 years. Denmark had a considerable interest in joining the e-Bug project to keep a focus on the low prevalence of bacterial resistance and the prevention of infectious diseases, and to maintain the acceptance of the immunization programme. Furthermore, the Danish Folkeskole, which is the Danish municipal primary and lower secondary school, uses the principle of differentiated teaching, integrating information technology, and there are no recommended textbooks in the curriculum. The teaching is organized so that it both strengthens and develops an individual students ability to act and care for themselves and for society in general. e-Bug, in its design, was seen as a tool that could be implemented well in the Danish Folkeskole, as it fulfils the goals on teaching methods and output. Two thousand e-Bug packs were printed, 100 local education authorities and 1507 school principals were contacted, and e-Bug was presented to important stakeholders in relevant scientific magazines and at meetings. It has been well accepted.
As a complement to the e-Bug teaching pack, two e-Bug games were developed to provide content that aimed to entertain as well as to educate. A set of agreed learning outcomes (LOs) were provided by the scientific partners of the e-Bug Project and the games were developed using user-centred design techniques (the needs, wants and limitations of the potential game players were assessed at each stage of the design process). The e-Bug games were designed for two age groups: Junior (9-12 year olds); and Senior (13-15 year olds). A study using focus groups was done to gain an understanding as to the types of games enjoyed by the target users. According to the preliminary study, the Junior Game was developed as a platform game and the Senior Game was developed as a story-based detective game. The Junior Game consists of five levels, each associated with a set of LOs. Similarly, the Senior Game consists of four missions, each comprising five stages using problem-based learning techniques and LOs. In this paper, the process of development for each game is described in detail and an illustration is provided of how each game level or mission addresses the target LOs. Development of the games used feedback acquired from children in four schools across the UK (Glasgow, London and two in Gloucester). The children were selected according to their willingness to participate. European Partners of the e-Bug Project also provided further support, translation and requests for modifications. The knowledge gained of LOs and further evaluation of the games is continuing, and preliminary results are in press. The final versions of the games, translated into 11 European languages, are available online via www.e-bug.eu.
Infection control differs among nations. Notably in USA strict measures are enforced to prevent air-borne tuberculosis (TB) transmission. In several European countries focus is on droplet transmission, close to patients. In the absence of strict evidence to resolve this divergence, an empiric, Danish guideline for infection control in hospitals is presented. If multi-drug resistant (MDR) TB is documented or suspected, according to risk-factors, patients should remain under air-borne precautions. The vast majority of Danish TB-patients (non-MDR) require less demanding, hygienic precautions.
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